C. diff, short for Clostridioides difficile, is a spore-forming bacterium that causes severe diarrhea and inflammation of the colon (colitis). C. diff produces hardy spores that can survive for months on surfaces and are resistant to many common disinfectants.
C. diff spreads through the fecal-oral route. When a person touches a contaminated surface and then touches their mouth, they can ingest C. diff spores and become infected. C. diff spores can contaminate many surfaces including:
- Toilets
- Bathroom sinks
- Bed rails
- Call buttons
- Door handles
- Linens
Infected patients shed large numbers of C. diff spores in their stool. If proper cleaning and disinfection does not occur, spores can persist in the environment and be transmitted to other patients.
Proper cleaning and disinfection of the environment is crucial to reduce C. diff contamination and prevent new infections.
Recommended Cleaning and Disinfection Methods
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To effectively combat C. diff, proper disinfectant selection and usage is critical.
Use EPA-approved disinfectants effective against C. diff spores
The U.S. Environmental Protection Agency (EPA) provides lists of registered disinfectants with specific claims against C. diff spores. Top options include:
- Bleach-based solutions containing 5000-6150 ppm sodium hypochlorite. A 1:10 dilution of household bleach contains ~6000 ppm.
- Accelerated hydrogen peroxide products (0.5-3%)
- Peracetic acid (0.2-0.35%)
- Chlorine dioxide
Focus on high-touch surfaces
High-touch surfaces in patient rooms and bathrooms provide prime opportunities for C. diff transmission. Prioritize disinfecting:
- Toilets
- Sinks
- Bed rails
- Call buttons
- Door handles
Also focus on nursing stations, hallways, and other common areas.
Clean before disinfecting
Cleaning before disinfection removes organic matter that can reduce disinfectant efficacy. The mechanical action of cleaning also helps detach C. diff spores from surfaces.
Follow contact time on disinfectant label
It’s critical to allow the product’s specified contact time for C. diff spores. This ensures the disinfectant has time to fully inactivate the spores.
Cleaning the Home
C. diff can spread in private homes, especially if a household member is infected. Proper cleaning and disinfection helps reduce contamination.
Make dilute bleach solution
The CDC recommends a dilute bleach solution containing ~1000 ppm sodium hypochlorite for disinfecting the home. To make this:
- Add 1 tablespoon of regular bleach to 1 quart (4 cups) of water OR
- Add 1/3 cup bleach to 1 gallon of water
This dilute bleach solution is effective against C. diff spores.
Focus on high-touch surfaces
In the home setting, pay special attention to:
- Toilets
- Faucets and sinks
- Door handles and knobs
- Light switches
- Phones and remote controls
Also disinfect any visibly soiled surfaces.
Wash laundry thoroughly if contaminated
Laundry contaminated with feces should be washed separately in hot water with bleach added to the wash cycle. This helps kill any C. diff spores present.
For best results, dry laundry in a hot dryer rather than air drying. The heat further helps inactivate spores.
Cleaning Healthcare Facilities
Stopping C. diff spread in hospitals, nursing homes, and clinics requires diligent cleaning efforts.
Use disinfectants effective against C. diff spores
Bleach-based solutions or EPA-approved sporicidal disinfectants should be used. Follow label instructions for proper dilution and usage.
Follow protocols for cleaning equipment and environment
Facilities should have written protocols for daily and terminal cleaning of:
- Patient rooms
- Bathrooms
- Nursing stations
- Equipment like ventilators, IV poles, walkers
- Common areas
Monitor cleaning practices
Direct observation and compliance monitoring ensure cleaning quality and adherence to protocols. Swab cultures can validate disinfection efficacy.
Use contact precautions for infected patients
Gowns and gloves should be worn for contact with C. diff patients or their contaminated environment. This prevents the spread to other patients.
Consistent, monitored cleaning is vital to control C. diff in healthcare settings.
Preventing Spread and Recurrence
Along with diligent environmental cleaning, C. diff prevention requires a multifaceted approach.
Hand hygiene with soap and water or alcohol-based sanitizers
Proper hand hygiene helps break the fecal-oral route of C. diff transmission.
- Soap and water physically removes spores
- Alcohol-based sanitizers don’t kill spores but reduce overall bioburden
Contact precautions for infected patients
Gowns and gloves should be worn when interacting with C. diff patients. Dedicated equipment should be used. This prevents the spread to other patients.
Antibiotic stewardship
Antibiotic overuse destroys healthy gut flora, increasing the risk for C. diff infection. Antibiotic stewardship programs promote judicious antibiotic prescribing.
Patient isolation when appropriate
Placing symptomatic C. diff patients under contact isolation precautions prevents transmission. Private rooms are ideal but cohorting patients may be needed.
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Conclusion
Proper cleaning and disinfection is critical to prevent C. diff spread
Diligent cleaning and disinfection using sporicidal disinfectants is the foundation for reducing C. diff transmission via contaminated surfaces. This environmental measure decreases the infectious burden and prevents spread.
Combining environmental measures, hand hygiene, and antibiotic stewardship provides a comprehensive strategy
Along with vigilant environmental disinfection, C. diff prevention requires:
- Proper hand hygiene
- Contact precautions for infected patients
- Antibiotic stewardship to reduce C. diff risk
Together, these interventions provide layers of defense against C. diff.
Consistent compliance with protocols is key challenge
The Achilles heel of many C. diff prevention programs is inconsistent compliance with cleaning protocols and procedures. Regular staff training, monitoring, and feedback help drive adherence and reduce infection rates.
Stopping C. diff requires a multifaceted approach with consistent diligence to all evidence-based prevention measures.
